Caring for the critically ill patients over 80: a narrative review

Guidet, Bertrand; Vallet, Hélène; Boddaert, Jacques; Lange, Dylan W. de; Morandi, Alessandro; Leblanc, Guillaume; Artigas, Antonio; Flaatten, Hans

doi:10.1186/s13613-018-0458-7

Cited by 114 publications

(120 citation statements)

References 130 publications

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“…Due to trauma-induced catabolism throughout hospitalization, Care for traumatized older people should consider the impact of aging on specific organ functions and, as a result, may affect interventions (26) . In this sense, interdisciplinary care improves quality because it addresses the comorbidities, processes, and outcomes of geriatric syndromes, identifies additional diagnoses, assists in advanced care planning, manages drug changes, and pain management (29) and identifies early risk factors for death (30) . There are gaps in the development and implementation of treatment protocols for traumatized elderly, lacking guidelines and specialized centers (26) .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for death of trauma patients admitted to an Intensive Care Unit

Lentsck

Oliveira

Corona

et al. 2020

Rev. Latino-Am. Enfermagem

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Objective: To analyze the risk factors for death of trauma patients admitted to the intensive care unit (ICU). Method: Retrospective cohort study with data from medical records of adults hospitalized for trauma in a general intensive care unit. We included patients 18 years of age and older and admitted for injuries. The variables were grouped into levels in a hierarchical manner. The distal level included sociodemographic variables, hospitalization, cause of trauma and comorbidities; the intermediate, the characteristics of trauma and prehospital care; the proximal, the variables of prognostic indices, intensive admission, procedures and complications. Multiple logistic regression analysis was performed. Results: The risk factors associated with death at the distal level were age 60 years or older and comorbidities; at intermediate level, severity of trauma and proximal level, severe circulatory complications, vasoactive drug use, mechanical ventilation, renal dysfunction, failure to perform blood culture on admission and Acute Physiology and Chronic Health Evaluation II. Conclusion: The identified factors are useful to compose a clinical profile and to plan intensive care to avoid complications and deaths of traumatized patients.

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Section: Discussionmentioning

confidence: 99%

Risk factors for death of trauma patients admitted to an Intensive Care Unit

Lentsck

Oliveira

Corona

et al. 2020

Rev. Latino-Am. Enfermagem

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“…The fact that sepsis at admission, after adjusting for organ dysfunction, was not independently associated with survival suggests that the best option today is assessing very old patients according to their age, frailty, and severity of illness, independently of their diagnostic category. Once admitted to ICU, we can establish goals of care and reassess the intensity of therapeutic interventions after a reasonable period of time, according to response to treatment, expected outcomes, and patient/family wishes [38].…”

Section: Discussionmentioning

confidence: 99%

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Ibarz

Boumendil

Haas

et al. 2020

Ann. Intensive Care

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Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.

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“…37 The number of elderly patients admitted to the intensive care units due to infections and related complications such as sepsis and acute respiratory failure has increased over recent decades. 38 Several limitations of our study should be noted. First, we did not adequately evaluate the effects of co-administered drugs such as glucocorticoids and prophylactic drugs for venous thromboembolism and stress ulcers.…”

Section: Discussionmentioning

confidence: 88%

Effect of CYP2C19 polymorphism on the plasma voriconazole concentration and voriconazole‐to‐voriconazole‐N‐oxide concentration ratio in elderly patients

Shang

Cheng

et al. 2020

Mycoses

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Background: Effects of CYP2C19 polymorphism on voriconazole concentration (C 0), dose-adjusted trough concentrations (C 0 /dose) and voriconazole-to-voriconazole-Noxide concentration ratio (C 0 /C N) have not been fully investigated. Objectives: To investigate correlations of CYP2C19 polymorphisms with plasma concentrations of voriconazole and the major metabolite voriconazole-N-oxide in elderly patients. Methods: A prospective, multi-centre, non-intervention, open clinical study was conducted within Southwestern Chinese patients clinically diagnosed with invasive fungal infections, to investigate the associations of CYP2C19 * 2 (681G > A), CYP2C19 * 3

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Caring for the critically ill patients over 80: a narrative review

Cited by 114 publications

References 130 publications

Risk factors for death of trauma patients admitted to an Intensive Care Unit

Risk factors for death of trauma patients admitted to an Intensive Care Unit

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Effect of CYP2C19 polymorphism on the plasma voriconazole concentration and voriconazole‐to‐voriconazole‐N‐oxide concentration ratio in elderly patients

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